Background Testing for canine blood types other than dog erythrocyte antigen 1.1 (DEA 1.1) is controversial and complicated by reagent availability and methodology. Objectives The objectives of this study were to use available gel column technology to develop an extended blood-typing method using polyclonal reagents for DEA 1.1, 1.2, 3, 4, 7, and Dal and to assess the use of gel columns for cross-matching. Methods Dogs (43–75) were typed for DEA 1.1, 1.2, 3, 4, 7, and Dal. Methods included tube agglutination (Tube) using polyclonal reagents, a commercially available DEA 1.1 gel column test kit (Standard-Gel) using monoclonal reagent, and multiple gel columns (Extended-Gel) using polyclonal reagents. Blood from 10 recipient and 15 donor dogs was typed as described above and cross-matched using the gel column technique. Results Of 43 dogs typed for DEA 1.1, 23, 25, and 20 dogs were positive using Standard-Gel, Extended-Gel, and Tube, respectively. Typing for DEA 1.2 was not achievable with Extended-Gel. For 75 dogs typed for DEA 3, 4, and 7, concordance of Extended-Gel with Tube was 94.7%, 100%, and 84%, respectively. Dal, determined only by Extended-Gel, was positive for all dogs. Post-transfusion major cross-matches were incompatible in 10 of 14 pairings, but none were associated with demonstrable blood type incompatibilities. Conclusions Gel column methodology can be adapted for use with polyclonal reagents for detecting DEA 1.1, 3, 4, 7, and Dal. Agglutination reactions are similar between Extended-Gel and Tube, but are more easily interpreted with Extended-Gel. When using gel columns for cross-matching, incompatible blood cross-matches can be detected following sensitization by transfusion, although in this study incompatibilities associated with any tested DEA or Dal antigens were not found.

Objective To compare accuracy and ease of use of a card agglutination assay, an immunochromatographic cartridge method, and a gel-based method for canine blood typing. Sample Blood samples from 52 healthy blood donor dogs, 10 dogs with immune-mediated hemolytic anemia (IMHA), and 29 dogs with other diseases. Procedures Blood samples were tested in accordance with manufacturer guidelines. Samples with low PCVs were created by the addition of autologous plasma to separately assess the effects of anemia on test results. Results Compared with a composite reference standard of agreement between 2 methods, the gel-based method was found to be 100% accurate. The card agglutination assay was 89% to 91% accurate, depending on test interpretation, and the immunochromatographic cartridge method was 93% accurate but 100% specific. Errors were observed more frequently in samples from diseased dogs, particularly those with IMHA. In the presence of persistent autoagglutination, dog erythrocyte antigen (DEA) 1.1 typing was not possible, except with the immunochromatographic cartridge method. Conclusions and Clinical Relevance The card agglutination assay and immunochromatographic cartridge method, performed by trained personnel, were suitable for in-clinic emergency DEA 1.1 blood typing. There may be errors, particularly for samples from dogs with IMHA, and the immunochromatographic cartridge method may have an advantage of allowing typing of samples with persistent autoagglutination. The laboratory gel-based method would be preferred for routine DEA 1.1 typing of donors and patients if it is available and time permits. Current DEA 1.1 typing techniques appear to be appropriately standardized and easy to use.

Objective To compare the ease of use and accuracy of 5 feline AB blood-typing methods: card agglutination (CARD), immunochromatographic cartridge (CHROM), gel-based (GEL), and conventional slide (SLIDE) and tube (TUBE) agglutination assays. Sample Population 490 anticoagulated blood samples from sick and healthy cats submitted to the Transfusion or Clinical Laboratory at the Veterinary Hospital of the University of Pennsylvania. Procedures Sample selection was purposely biased toward those from anemic, type B, or type AB cats or those with autoagglutination. All blood samples were tested by use of GEL, SLIDE, and TUBE methods. Fifty-eight samples were also tested by use of CARD and CHROM methods. The presence of alloantibodies in all cats expressing the B antigen as detected by use of any method was also assessed. Results Compared with the historical gold-standard TUBE method, good to excellent agreement was achieved with the other typing tests: CARD, 53 of 58 (91% agreement); CHROM, 55 of 58 (95%); GEL, 487 of 490 (99%); and SLIDE, 482 of 487 (99%; 3 samples were excluded because of autoagglutination). Four of the samples with discordant test results originated from cats with FeLV-related anemia. Conclusions and Clinical Relevance Current laboratory and in-clinic methods provide simple and accurate typing for the feline AB blood group system with few discrepancies. Retyping after in-clinic typing with the GEL or TUBE laboratory methods is recommended to confirm any type B or AB cats.

Objective -To determine if absolute plasma lactate concentration or lactate clearance in dogs with septic peritonitis is associated with morbidity or mortality. Design -Retrospective cohort study from 2007 to 2012. Setting -University teaching hospital. Animals -Eighty-three dogs with septic peritonitis were included. Patients had at least 1 plasma lactate measurement during the course of the hospitalization. Results -Sixty-four percent of the patients survived to discharge, 22% were euthanized, and 14% died during hospitalization. Plasma lactate concentration >2.5 mmol/L on admission (29% of the patients) was associated with mortality (P = 0.001). Median admission plasma lactate concentration (n = 81) was significantly different between nonsurvivors (2.5 mmol/L, range 0.5-8.4) and survivors (1.4 mmol/L, range 0.5-9.7; P = 0.007). Admission plasma lactate concentration >4 mmol/L yielded a sensitivity of 36% and a specificity of 92% for nonsurvival. The inability to normalize plasma lactate concentration within 6 hours of admission (n = 10/24) yielded a sensitivity of 76% and specificity of 100% for nonsurvival. Postoperative hyperlactatemia (plasma lactate concentration >2 mmol/L; n = 18/76) had a sensitivity of 46% and specificity of 88% for nonsurvival. Persistent postoperative hyperlactatemia (n = 11/18) had a sensitivity of 92% and a specificity of 100% for nonsurvival. Lactate clearance less than 21% at 6 hours (n = 20) had a sensitivity of 54% and specificity of 91% for nonsurvival. Lactate clearance less than 42% at 12 hours (n = 18) had a sensitivity of 82% and a specificity of 100% for nonsurvival. Conclusions -Admission plasma lactate concentration and lactate clearance were good prognostic indicators in dogs with septic peritonitis. Crit Care 2015; 25(3): 388-395) (J Vet Emerg

Blood salvage has been safely used in human medicine for decades and is feasible in veterinary medicine. Potential advantages include reduced reliance on banked blood for massive transfusions and minimization of morbidities associated with the use of allogeneic and stored blood products. Concerns about the safety of salvaged blood have been largely dispelled in human medicine but further investigation regarding the safety of such procedures in veterinary patients is warranted.

Background: Abnormal sodium to potassium (Na : K) ratios can raise suspicion for hypoadrenocorticism (HA). Although dogs with HA usually have normal leukograms, their white blood cell counts may be useful in screening for HA.Objectives: To examine the utility of combining the Na : K ratio with white blood cell counts to screen for HA in hospitalized dogs requiring fluid treatment administered IV.Animals: Fifty-three dogs with confirmed HA and 110 sick dogs confirmed not to have HA.Methods: Retrospective, case-control study. Dogs were included if they were hospitalized and administered fluids IV, had a complete blood count and measurement of serum Na and K concentrations. HA was diagnosed using an ACTH stimulation test, or ruled out by measurement of basal serum cortisol concentration.Results: The receiver operating characteristic (ROC) curve for the lymphocyte count was not significantly different from the ROC curve of the Na : K ratio (P = .55). The ROC curve for the model combining the Na : K ratio and lymphocyte count was superior for identifying dogs with HA compared to the Na : K ratio (P = .02) or lymphocyte count (P = .005) alone. At the 100% sensitivity cutoff, lymphocyte count was more specific for detection of HA than Na : K (P < .001).Conclusions and Clinical Importance: A combination of the Na : K ratio and lymphocyte count provides a better screening test for HA compared to the Na : K ratio or lymphocyte count alone. At 100% sensitivity, the lymphocyte count is a more specific test for HA than the Na : K.

Objectives The aim of this study was to report the prevalence of iatrogenic hypothyroidism, with or without azotaemia, based on the measurement of serum total thyroxine (T4), thyroid-stimulating hormone (TSH) and creatinine concentrations, in hyperthyroid cats undergoing radioiodine (131I) treatment where the 131I dose was calculated using a previously described scoring system. A secondary aim of the study was to determine the positive and negative predictive values of serum T4 and TSH concentrations obtained 19 days after treatment in order to predict the development of iatrogenic hypothyroidism 6–9 months after 131I treatment. Methods Serum T4, TSH and creatinine concentrations were measured 19 days and 6–9 months after 131I treatment. The prevalence of iatrogenic hypothyroidism was assessed with the results obtained 6–9 months after 131I treatment. Results The prevalence of overt and subclinical hypothyroidism 6–9 months after 131I treatment was 40.0% (22/55 cats) and 12.7% (7/55 cats). Overt hypothyroidism with azotaemia was diagnosed in 8/55 (14.5%) cats. The positive and negative predictive values for the prediction of the development of iatrogenic hypothyroidism 6–9 months after 131I treatment were 72.2% and 80.0%, respectively, for a low serum T4 concentration, and 75.0% and 44.6%, respectively, for an increased serum TSH concentration. Conclusions and relevance The use of an individualised scoring system is effective in determining the 131I dose for the treatment of hyperthyroid cats. However, the prevalence of overt hypothyroidism was higher in comparison with other studies using different dosing protocols. Further studies comparing the efficacy of individualised scoring systems and different fixed doses to determine which method is superior are warranted.

Evidence before this study: Acute appendicitis is the most common general surgical emergency in children. Its diagnosis remains challenging and children presenting with acute right iliac fossa (RIF) pain may be admitted for clinical observation or undergo normal appendicectomy (removal of a histologically normal appendix). A search for external validation studies of risk prediction models for acute appendicitis in children was performed on MEDLINE and Web of Science on 12 January 2017 using the search terms ["appendicitis" OR "appendectomy" OR "appendicectomy"] AND ["score" OR "model" OR "nomogram" OR "scoring"]. Studies validating prediction models aimed at differentiating acute appendicitis from all other causes of RIF pain were included. No date restrictions were applied. Validation studies were most commonly performed for the Alvarado, Appendicitis Inflammatory Response Score (AIRS), and Paediatric Appendicitis Score (PAS) models. Most validation studies were based on retrospective, single centre, or small cohorts, and findings regarding model performance were inconsistent. There was no high quality evidence to guide selection of the optimum model and threshold cutoff for identification of low-risk children in the UK and Ireland. Added value of this study: Most children admitted to hospital with RIF pain do not undergo surgery. When children do undergo appendicectomy, removal of a normal appendix (normal appendicectomy) is common, occurring in around 1 in 6 children. The Shera score is able to identify a large low-risk group of children who present with acute RIF pain but do not have acute appendicitis (specificity 44%). This low-risk group has an overall 1 in 30 risk of acute appendicitis and a 1 in 270 risk of perforated appendicitis. The Shera score is unable to achieve a sufficiently high positive predictive value to select a high-risk group who should proceed directly to surgery. Current diagnostic performance of ultrasound is also too poor to select children for surgery. Implications of all the available evidence: Routine pre-operative risk scoring could inform shared decision making by doctors, children, and parents by supporting safe selection of lowrisk patients for ambulatory management, reducing unnecessary admissions and normal appendicectomy. Hospitals should ensure seven-day-a-week availability of ultrasound for medium and high-risk patients. Ultrasound should be performed by operators trained to assess for acute appendicitis in children. For children in whom diagnostic uncertainty remains following ultrasound, magnetic resonance imaging (MRI) or low-dose computed tomography (CT) are second-line investigations.